Original Article
Etiology of Chylothorax in 203 Patients

https://doi.org/10.4065/80.7.867Get rights and content

OBJECTIVES

To characterize the etiology of chylothorax in patients encountered at a single tertiary referral center and to compare the findings with those from previous studies.

PATIENTS AND METHODS

The medical records of all patients with chylothorax seen at the Mayo Clinic in Rochester, Minn, over a 21-year period, from January 1, 1980, to December 31, 2000, were retrospectively reviewed to ascertain the underlying cause of their condition.

RESULTS

We identified 203 patients with chylothorax; 92 were females (male-female ratio, 1.21). The median age was 54.5 years (range, 21 weeks' gestation to 93 years). Dyspnea, the most common presenting symptom, occurred in 98 (56.6%) of 173 patients in whom initial symptoms were recorded, whereas 64 (37.0%) had no respiratory symptoms. Median duration of symptoms before diagnosis was 7.5 weeks (range, 1 day to 4.5 years). Causes of chylothorax included surgery or trauma in 101 patients (49.8%), various medical conditions in 89 (43.8%), and unknown in 13 (6.4%). Among surgical procedures, esophagectomy (29 patients) and surgery for congenital heart disease (28 patients) were the most common causes of chylothorax. Among medical conditions, lymphoma (23 patients), lymphatic disorders (19 patients), and chylous ascites (16 patients) were the most common causes.

CONCLUSIONS

Chylothorax has numerous causes. In contrast to previous studies, surgery or trauma was the most common cause of chylothorax at our institution, accounting for nearly 50% of cases. Lymphoma and other malignancies caused chylothorax in only 16.7% of cases. These numbers are possibly related to the high volume of cardiothoracic surgical procedures performed at our tertiary referral center.

Section snippets

Patients and Methods

All patients with chylothorax seen at the Mayo Clinic in Rochester, Minn, over a 21-year period, from January 1, 1980, to December 31, 2000, were identified by a computer-assisted search of medical records. The presence of a chylothorax was defined by 1 or more of the following inclusion criteria: (1) a pleural fluid triglyceride level of 110 mg/dL or greater, (2) the presence of chylomicrons in the pleural effusion, or (3) a chylous leak into the pleural cavity documented on lymphangiography

Results

The study included 203 patients, 111 males and 92 females, with a median age of 54.5 years (range, 21 weeks’ gestation [thoracentesis performed in utero] to 93 years) (Table 1). Presenting symptoms were documented in 173 patients. Dyspnea was the most common symptom and was present in 98 patients (56.6%). At initial presentation, 64 (37.0%) of the 173 patients had no respiratory symptoms. Two patients (1.2%) reported chyloptysis. The median duration of symptoms before diagnosis was 7.5 weeks

Discussion

Chylothorax can occur in various clinical settings and arise from diverse causes. Tumor has been the most common cause in most case series and was responsible for approximately one half of cases.2 The primary tumor itself or metastatic disease can extrinsically compress or directly invade the thoracic duct. Chylous leakage can result from either a rupture of the duct secondary to back pressure or direct tumor invasion of the duct.2 Traditionally, lymphoma accounted for approximately three

Conclusions

We have shown that chylothorax can be attributable to numerous etiologies, but the percentage of postoperative chylous effusion has increased relative to previous series. Although malignancy still plays a major etiologic role and various nonmalignant etiologies exist, the development and growth of cardiothoracic surgical procedures at our tertiary referral center may have resulted in the number of surgery-related causes (nearly 50%) surpassing the number of malignant causes (16.7%) of

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